Health Claims Specialist
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Job Description
Claims Examiner processing medical claims for healthcare. Working independently, ensuring accurate adjudication and compliance with policies.
Responsibilities:
- Work independently, processing claims via data entry for 90% of your day.
- Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines
- Follow up on claims needing additional information
- Refer problem claims to a Lead and/or auditor for additional review
- Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines
- Work with specific software
- May be assigned special projects
Requirements:
- High School Diploma or equivalent
- Excellent Internet Connectivity: Internet access speed of 2 Mbps upload and 10 Mbps download.
- A quiet and distraction-free, secure place to work
- Effective verbal and written communication skills
- Strong typing and analytical abilities
- Multi-tasking skills with a strong attention to detail
- Computer knowledge
- Minimum 40 words per minute on typing test
- Must have and maintain a clean and paper free work environment to meet our company policies.
- Medical Billing and Coding degree/certification.
- Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, with an understanding of the different types of insurance (Medicare/Medicaid and/or Child Plus).
- Knowledge of Medical terminology
Benefits:
- Medical, dental, and vision plans.
- Paid training and PTO (be sure to ask about our Global Flexible Vacation Policy).
- Company-provided equipment.
- Advancement opportunities – 80% of our frontline leaders have been promoted from within.
- Monthly rewards & recognition programs.
- Employee Discounts.
- EAP and Health and Wellness programs including a personal trainer dedicated to Sutherland.
- Weekday schedule, Monday – Friday 8:30 AM – 5:00 PM EST.
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